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Pakistan tackles high rates of hepatitis from many angles – (July 2017)

On World Hepatitis Day, WHO is calling on countries to step up efforts to eliminate hepatitis by 2030. With one of the world’s highest rates of hepatitis C, Pakistan is tackling this serious health issue from many angles to improve prevention, diagnosis and treatment.

When 48-year old Ali* arrived at the clinic after travelling 350kms to the city of Lahore, he was almost certain that he would die. He was very sick with hepatitis C and had seen four of his siblings die from the same disease.

Ali was lucky. He had come to the recently opened hepatitis clinic of the Pakistan Kidney and Liver Institute and Research Center (PKLI) in Lahore, Pakistan. When he was told that medicines were available that could cure his disease, he started to cry. He just couldn’t believe it.

“I know how I got infected,” says Ali, who recalls that his local barber used unhygienic instruments that were the likely source of the virus that infected him and his siblings.

Pakistan has the world’s second highest prevalence of hepatitis C, second only to Egypt. A survey done in 2007 found that close to 7% of people in the province of Punjab had hepatitis C, while around 5% of people were infected in the entire country.

Unsafe injections and unhygienic instruments are major cause of spread

“The high prevalence of hepatitis is due to many factors in both health care settings and in the community,” says Dr Saeed Akhter, President of the PKLI. “This includes use of dirty syringes, failure to screen blood before transfusion, use of unhygienic dental instruments, reuse of razor blades by barbers and poor infrastructure for infectious waste disposal.”Hepatitis C is a bloodborne virus that can cause liver disease that ranges from a short, mild illness to a serious, lifelong condition. WHO estimates that approximately 71 million people worldwide have chronic hepatitis C infection and around 400 000 people die every year from it, mostly from cirrhosis or liver cancer. While there is no vaccine against hepatitis C, antiviral medicines can cure more than 95% of people with the disease.

Unsafe injections play a major role in transmitting hepatitis C. The Government of Punjab is the first province in Pakistan to address this issue by introducing a policy to ensure that 90 % of all syringes used in the health sector are auto-disable, meaning that they cannot be used more than once. In addition, it has launched a programme to improve infectious waste control that includes building 39 incinerators in health facilities.

“The 2015 WHO Guidelines on Injection Safety recommend that all countries should switch to exclusive use of safety-engineered syringes,” says Dr Arshad Altaf, injection safety expert at WHO. “The policy switch in Punjab province is a step in the right direction and will play a key role in preventing reuse of syringes, a major risk factor in transmitting hepatitis C.”

Expanding access to lifesaving treatment

While prevention is key in the fight to eliminate hepatitis, access to testing and treatment is essential to saving the lives of those people already infected.

The collaboration of Government of Punjab with PKLI is a good example of public private partnership for the prevention and control of viral hepatitis. In just four months since this partnership has been developed, more than 10 000 patients have been tested for hepatitis B and C and, where needed, treated free of cost without discrimination. This programme, based on guidance from WHO and the US Centers for Disease Control and Prevention (CDC), is now being expanded to 25 districts across the province of Punjab.

Government of Pakistan provides free diagnosis, treatment and care to hepatitis patients in all provinces through four Hepatitis Prevention and Control programmes. Hepatitis C patients now have free access to new oral medicines, thanks to work done by the National Technical Advisory Group of hepatitis experts, which has been instrumental in bringing down the cost of drugs for hepatitis C treatment to less than 1% of the cost paid in the USA.

Eliminating hepatitis is the goal

Political support is essential to tackling hepatitis. “When we demonstrated the seriousness of the situation to the Chief Minister of Punjab – showing him how many people get sick and die from hepatitis here – he took personal interest and pledged full support, including passing new laws to help prevent hepatitis infection,” says Dr Akhter.

In August, Pakistan Ministry of Health will launch its first National Hepatitis Strategic Framework that follows closely WHO’s Global health sector strategy on viral hepatitis. It outlines a clear set of targets and objectives to help Pakistan work towards the goal of eliminating hepatitis by 2030 so that people like Ali no longer have to risk death from a simple visit to the barber.